Continence – 12 month results

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Continence results at twelve months for index patients

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Study group: Index patients | Non-index patients | High risk patients | All patients
Approach: Open | Laparoscopic
Age: 40-49 | 50-59 | 60-69 | 70+

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The pie-chart below shows traffic light results for index patients from the one-year follow up questionnaire.

Key

Number of patients per year for index patients

Raw data: continence results at 12 months for index patients

Total number of patients: 266
Total green: 231
Total yellow: 21
Total red: 6

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Live results FAQ

Why are we recording and presenting data in this way?

This traffic light study for results is significantly different to the way research is traditionally undertaken and presented.

For the first time in the field of prostate cancer treatment, patients can individually track and compare their progress with other patients. We are using clearly measurable and understandable terms, avoiding traditional terms such as ‘erectile recovery’ which are unclear.

The traffic light study is an ongoing process – it is not a ‘snapshot’ taken from a fixed period of time. Patients and prospective patients can see how many men have taken part in the study and when the results were last updated.

Why are we focusing on erectile function and continence after prostate cancer surgery?

The primary objective of prostate cancer surgery is full and complete cancer clearance. This type of operation, the prostatectomy, is very effective for cancer clearance. The outcomes which do vary very widely however, are erectile dysfunction and incontinence as a result of this surgery. These are outcomes which matter a great deal to patients.

We are providing a clearer and more comprehensive focus on these outcomes to enable patients to understand what to expect before surgery and compare their progress after surgery. We can discuss all aspects of this operation with you but our experience from treating thousands of men is that erectile function and continence are the outcomes that matter to patients.

What do the traffic lights mean?

Erectile function
	Green: Sufficient for full sexual intercourse
	Light Green: Sufficient for masturbation /foreplay but not full sexual intercourse
	Amber: Some enlargement but not sufficient for sexual activity
	Red: No enlargement
	Grey: Awaiting response from patient

Continence
	Green: No pads (or precautionary pad only)
	Amber: One pad per day
	Red: Two or more pads per day
	Grey: Awaiting response from patient

How do we measure each patient’s status?

If a patient agrees to join the Traffic Light study, in addition to normal follow-up appointments, they are asked to complete a questionnaire every three months for a year. We use the EPIC questionnaire. This is a questionnaire which has been used extensively worldwide as the most accurate way of assessing erectile function.

Are all patients included?

Yes – all patients having a radical prostatectomy are invited to join the results centre and the vast majority do so. Patients are carefully placed into three different categories. This is because nerve-sparing depends upon the extent of your prostate cancer ie if your cancer cells are beginning to breach the wall of your prostate, the surgeon will need to take wide margins in order to achieve cancer clearance. Therefore nerve-sparing will be limited, compared with a man who has lower risk disease. We also consider erectile function before surgery because inevitably this will influence erectile recovery after surgery.

How are patients classified?

Index: a patient whose prostate cancer has not spread beyond the prostate gland itself (stage T1 or stage T2). The patient will also have good erectile function, sufficient for sexual intercourse, before surgery. There is no upper age limit to this group, although motivation and opportunity to return to sexual intercourse is important. In simple terms, index patients should have no adverse clinical factors to affect full erectile recovery. This makes the quality of nerve sparing the main outcome determing factor.

Non-index: a patient will be in this category if he does not have good quality erections before surgery, or if it is clinically inapporpriate to perform high qulaity nerve sparing because the prostate cancer is considered too aggresive or extensive. Similarly, a patient would also be considered non-index if erectile recovery is not a priority for him.

High risk: a high-risk patient has aggressive prostate cancer which may have breached the prostate gland but it is still possible to have surgery with curative intent, often including extended lymph node dissection. For this group, wide margins around the prostate are usually taken, so the risk of erectile dysfunction is higher and continence sometimes takes longer to return. Similarly patients who have had previous treatments such as HIFU, radiotherapy or TURP are included in this group.

What about patient confidentiality?

Patient confidentiality is a paramount concern. Patients who consent to join the traffic light study are given a number. The patient and clinic staff are the only ones to know which patient is ascribed a particular number. The patient can then log in with their individual number, chart their own progress and see how it compares with anonymous others.

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